Healthcare Provider Details

I. General information

NPI: 1578508966
Provider Name (Legal Business Name): FAMILY MEDICAL CARE OF BREVARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 FORTENBERRY RD
MERRITT ISLAND FL
32952-3619
US

IV. Provider business mailing address

258 FORTENBERRY RD
MERRITT ISLAND FL
32952-3619
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-3638
  • Fax: 321-452-1185
Mailing address:
  • Phone: 321-453-3638
  • Fax: 321-452-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT H PAXSON
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 321-453-3638